Healthcare Provider Details

I. General information

NPI: 1114519998
Provider Name (Legal Business Name): IAN MICHAEL CAUDLE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 HOSPITAL DR
HIGHLANDS NC
28741-7600
US

IV. Provider business mailing address

190 HOSPITAL DR
HIGHLANDS NC
28741-7600
US

V. Phone/Fax

Practice location:
  • Phone: 336-214-4207
  • Fax:
Mailing address:
  • Phone: 828-526-1463
  • Fax: 828-526-1472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30215
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: